Beverly was never resistant to aging. In fact, she welcomed it. But she couldn’t always embrace the changes brought by time. After menopause, she began experiencing hot flashes with increasing frequency, and for the first time in her life, it was difficult to achieve deep sleep and feel rested the next morning. Her energy level also fell; whereas she had once been thrilled to live in a walkable neighborhood, she found herself driving more and more. She could no longer take for granted the resiliency she once had.
Despite these changes, Beverly didn’t reach out to her doctor until she started to experience pain and bleeding with sex. These concerned her more than the other symptoms, which she saw as uncomfortable but not unbearable. Bleeding and pain were different than being a bit more tired.
After a complete physical exam and comprehensive hormone testing, Beverly’s health care practitioner determined that she was experiencing estrogen deficiency to an extent that could explain the changes in her daily temperature regulation, her sleep, her overall energy, and—most significantly—the pain and bleeding that were affecting her sex life. What’s more, she learned hormone replacement therapy (HRT) is an effective treatment for menopausal bleeding and other symptoms of low estrogen. With custom-compounded hormone therapy, Beverly’s estrogen levels were replenished and her symptoms relieved, restoring her energy, her sleep, and her sex life.
Speaking to her doctor was a turning point for Beverly. Unfortunately, many women continue to endure uncomfortable symptoms without reaching out for help. They may be embarrassed to talk about vaginal bleeding with their doctors, or they may not realize that it can be a sign of a potentially serious health condition. But speaking up about menopausal bleeding is essential to ensuring you get the care you need and protecting your health.
The Causes of Menopausal Bleeding
Whereas bleeding of various kinds can be normal and expected for women in their reproductive years, menopausal bleeding is never normal.
Menopause is triggered by the decline in estrogen that eventually causes a permanent end to the reproductive cycle. While you may experience perimenopausal menstrual irregularities for years, once you have gone a full 12 months without a period, you have officially entered menopause. If bleeding is occurring after that threshold, it’s important to speak with your doctor right away. Such bleeding can not only be inconvenient and uncomfortable, it could also point to a serious problem—and treatment for menopausal bleeding is likely close at hand.
Some of the causes of menopausal bleeding and other distressing symptoms include:
Vulvar and vaginal atrophy (VVA) is experienced by as many as half of all postmenopausal women. The most common symptoms of vaginal atrophy are dryness, irritation, and itching, all of which result from inadequate levels of estrogen. In the absence of moisture and elasticity, sexual activity can bring pain, discomfort, and bleeding. Significantly, this condition does not resolve itself without treatment; in fact, it’s likely to get worse.
Women of any age may experience cervical polyps, either alone or in groups. While premenopausal women are more likely to experience polyps in the cervical canal (endocervical polyps), postmenopausal women are at increased risk of polyps on the outer layer of the cervix (ectocervical polyps). While the cause of cervical polyps is not fully understood, they are known to be associated with inflammation of the cervix and may be affected by changing levels of or responses to estrogen after menopause. Symptoms of polyps can include bleeding and discharge as well as discomfort and bleeding specifically related to sexual activity.
The endometrium is the inner lining of a woman’s uterus; it is the layer that adapts during the menstrual cycle, growing and then shedding in response to oscillating levels of estrogen and progesterone. Following menopause, however, the body does not receive the same hormonal cues to regenerate. Endometrial atrophy occurs when estrogen levels are low enough that the endometrium gets extremely thin and bleeding may occur.
While endometrial atrophy is a lack of endometrial lining, endometrial hyperplasia is an excess, likely due to an oversupply of estrogen without an adequate level of progesterone to balance it out. Bleeding can occur as a sign of this inflammatory condition. There is also a risk of these endometrial cells to become abnormal and develop into cancer.
According to the American Cancer Society, “cancer of the endometrium (the lining of the uterus) is the most common cancer of the female reproductive organs” and is most common in postmenopausal women, with 60 being the average age of diagnosis. However, it is also highly detectable and treatable, with a 5-year survival rate of 96% for women with localized endometrial cancer. Cancer could be one explanation for bleeding and pelvic pain after menopause, and early detection can help you get the treatment you need as soon as possible.
Irregular bleeding can be unsettling, even frightening. Getting the right diagnosis is essential to understanding what you are experiencing and starting the treatment you need to mitigate any further risks to your health.
Getting the Right Treatment for Menopausal Bleeding
Menopause is a time of hormonal transformation. Adapting to this transformation can be challenging after decades of familiar cycles. But you do not have to simply suffer through this transition and deal with symptoms like vaginal atrophy—nor should you assume that all new or uncomfortable symptoms you experience during this time are attributable to menopause. Rather, these symptoms should be discussed with a trusted health care practitioner. This is particularly true when it comes to bleeding.
With a thorough assessment of your health, symptoms, and medical history, an experienced practitioner can investigate the bleeding and any other symptoms that are interfering with your well-being. Depending on your individual situation, diagnosis may involve imaging, sampling and biopsy, and/or hysteroscopy. Your practitioner may also conduct hormone testing to determine if hormones may be the cause—and possible treatment—for menopausal bleeding.
Many of the conditions commonly associated with bleeding after menopause have predictable, effective courses of treatment:
For vaginal atrophy, estrogen replacement therapy can be an important start to treatment and recovery. Researchers have found that HRT can alleviate symptoms of vaginal atrophy by improving circulation and regeneration of collagen in the vagina and surrounding areas. Additionally, treatment is highly effective; a 2018 review found that that systemic HRT—such as pills, patches, and pellets—relieve symptoms in 75% of cases. Topical therapy—such as creams and gels—has even greater efficacy, relieving the symptoms of vaginal atrophy in 80–90%.
Cervical polyps may call for surgical removal and biopsy to rule out cancerous growth. HRT may also be used to prevent further hormone-related growths.
Because endometrial atrophy can be traced to estrogen levels, estrogen hormone replacement therapy is often an ideal option for relieving symptoms, including menopausal bleeding.
Hyperplasia in the uterus is likely the result of excess estrogen without enough progesterone. As such, progesterone hormone therapy may allow you to restore hormone balance and health to the endometrium. Surgery may also be used to correct endometrial hyperplasia if other options are not effective.
Treatment for endometrial cancer often involves multiple therapies, including surgery, radiation therapy, and chemotherapy, and is largely guided by the stage of the cancer and the preferences of the patient. Working with an experienced oncologist is essential to determining the best approach.
Regardless of the cause of your menopausal bleeding, protecting your health and well-being can only begin when you reach out for help.
Getting the Right Guidance for Your Future
If you are experiencing bleeding after menopause, don’t prolong your discomfort. Seeking the guidance of a medical professional will allow you to discover what lies at the root of your bleeding and how to move forward. If HRT is determined to be an appropriate treatment for your menopausal bleeding, connecting to a practitioner who specializes in hormone replacement therapy can be a vital part of your healing journey.
It’s also important to note that while HRT may be a core part of treatment for menopausal bleeding, it can also help you find relief from a broad range of menopause symptoms. In fact, some researchers believe that it may help protect long-term health when initiated within 10 years of menopause, support your overall well-being and reduce the risk of conditions such as osteoporosis, coronary heart disease, and dementia.
With the right strategy, you can be on your way to greater comfort and resiliency now and in the years ahead.
If you are concerned about menopausal bleeding or want to know more about HRT, BodyLogicMD can help. The practitioners in the BodyLogicMD network are top specialists in hormone health, menopause-related health concerns, and hormone replacement therapy. With the guidance of a BodyLogicMD-affiliated practitioner, you can get to the root of your symptoms and develop a personalized treatment plan using the most advanced therapies available today. You can contact a local practitioner to make an appointment, or take the BodyLogicMD Hormone Balance Quiz to learn more about how hormones may be affecting your daily life.
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended to diagnose, treat, cure or prevent diseases.
Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.